Outline

Objective

Visual field testing is an important component of evaluating the visual system. In children, testing is hampered by fatigue effects, easy distraction and lack of comprehension. Recently a variety of new testing strategies for automated perimetry has been developed, but due to the difficult testing in children these have mainly been tested on adults. Therefore many examiners feel uncertain about which strategy should be used in an individual child.

Studies

SITA (Humphrey-perimeter), TOP (Octopus), CLIP and fast threshold (Oculus), as well as FDT (frequency-doubling perimetry) are new testing strategies for automated static perimetry. Examinations with these strategies have been possible in many children starting from about 8 years of age (Donahue 2001, Morales 2001, Wabbels 2004, Blumenthal 2004). Successful testing was determined not only by age, but also by the child's maturity and motivation. Tschopp and Safran (1995-99) were able to test many children starting from 5 years on with suprathreshold strategies, when a specially designed teaching program had been performed before the test. Children with disturbances of the visual system could in fact have more problems performing visual field testing, but there are no systematic studies. Lately, automated kinetic perimetry has been introduced. First results in children demonstrate good reproducibility in the periphery, whereas central isopters are more difficult to test, especially in younger children.

Conclusions

As of now, new testing strategies for automated static perimetry allow to determine thresholds in many children from 8 years on. Nevertheless, testing is time consuming and needs patience. Many children between 5 and 8 years are able to perform suprathreshold testing, provided that a familiarisation phase is done before the test. Automated kinetic perimetry could be used to reliably monitor children under antiepileptic vigabatrin therapy.